It is the second time the court has considered the matter. In 2006, Presbyterian and Carolinas HealthCare System challenged regulators' choice of Piedmont.

Carolinas Medical Center-Fort Mill rendering In 2009, an administrative law court judge ordered the process be started over because the state Department of Health and Environmental Control had misinterpreted the state's health plan in making its decision.

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That decision set off another heated competition for the Fort Mill hospital that played out during many public meetings, on billboards along Interstate 77, and in thousands of letters of support for each applicant.

The cost to build a new hospital is in the millions, but whoever finally gets to proceed will shape health care in York County for years to come.

Carolinas Medical Center's plans call for a $77.5 million, 64-bed hospital at the intersection of Sutton Road and Interstate 77 with a projected net income of $431,000 in the first year, increasing to $2.5 million in the third year.

A spokeswoman with Piedmont Medical Center said the hospital has appealed the decision but declined to elaborate. Charles Miller, Piedmont's president and chief executive officer, was not available for comment.

A Presbyterian spokeswoman said, "We understand the residents of York County have long waited for a hospital to be built in Fort Mill and that any further delay causes the community even more disappointment.

"However, after a careful consideration, we have determined we will appeal the DHEC decisions. We believe the integrity of certificate-of-need law was not upheld. DHEC staff based its decisions on the mistaken belief that, because Carolinas Healthcare System already has a significant market share in York County, CHS' proposal would have the least impact on Piedmont Medical Center.

"Protecting an existing provider's market share is not a criterion for certificate of need review. Additionally, the basis for the decision consequently prevented Presbyterian's proposal from being fairly considered."

Presbyterian made similar arguments in its appeal for a hearing by the DHEC board. The board, on a 3-2 vote, declined to hear appeals by Presbyterian and Piedmont.

A spokesman with Carolinas HealthCare System said, "Based on the history of this case, we are very hopeful this appeals process will proceed as quickly as possible. We are confident that Carolinas HealthCare System will prevail in the appeals process based on the merits of our Certificate of Need application. We believe DHEC made a sound decision based on the CON (certificate of need) review criteria and the facts in the DHEC record."

The filing is the first of many steps in the appeals process, a clerk with the court said Monday. Some filings are accompanied with detailed information, while other filings are a simple letter, the clerk said.

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